30 Aug 12 Step Programs and Personality Type
There are a lot of statistics tossed around about the effectiveness of twelve-step programs for addiction. They usually revolve around low success rates and high rates of dropouts within a month, but getting to the bottom of them isn’t easy. Conflicting agendas mean that certain results are paraded around more than others and that people looking for the truth about the effectiveness of twelve-step treatment and its retention rates are left as confused as when they started. There is also another troubling consideration: if these claims are true, why don’t some people respond to twelve-step treatment?
Finding out the effectiveness of twelve-step or AA treatment is not a simple matter. Many of the studies conducted have not used a control group, and if they do, it’s almost always another form of therapy. The Cochrane Library regularly publishes reviews of multiple randomized controlled trials in order to draw more weighty conclusions on a wide range of topics. A review of the effectiveness of AA found that “no experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.”
Data on the retention rate of AA and twelve-step programs is similarly unflattering. AA’s own research between 1977 and 1989 found that 81 percent of alcoholics dropped out of treatment in the first month. Another study that looked at the retention rates of various treatments found that 68 percent of those who attended AA dropped out, 22 percent more than any other treatment studied. Some data also indicates that 95 percent of people who attend AA leave within the first year.
It’s clear from the data – regardless of any criticisms or conflicting research – that something isn’t going according to plan with twelve-step treatment. By most accounts, the majority of people who attend will leave, and there is no evidence of it having benefits over any other type of therapy. Despite the criticisms, there are many people who benefit enormously from the twelve-step program and involvement with AA, but on the other hand, some people can be hugely against it. To get to the bottom of this problem, it’s useful to analyze the opposition’s argument. After all, those who oppose the twelve steps are likely to be the first month dropouts.
12 Step Programs Fostering Dependence
A particularly interesting criticism of AA rehabilitation programs relates to dependent and independent personalities. There are inherent problems with classifying personalities in this way, because people are usually a complex mixture of various personality types, not one of several ordered “types.” For the purposes of this debate, all we need to accept is that some people are dependent and some are independent. Basically, dependent people rely on external things for support, and independent people want to do things their own way. Faced with the task of cooking a chili, a dependent person will meticulously follow the recipe learned from a friend or found in a cookbook, and an independent person will use their basic knowledge of how to make a chili and do the rest however they think will work.
The criticism of AA or twelve-step therapy is that it fosters dependence and is therefore is repulsive to independent individuals. Looking at the twelve steps reveals that this may well be the case. The core belief is that only by turning your life over to a higher power (of some description), admitting and making amends for your shortcomings, and accepting your powerlessness will you achieve sobriety. The higher power is the only one who can take away your shortcomings and help you stay clean.
For an independent personality, the message here is “You are not capable of solving your own problems.” A simple generalization would be that independent people are less likely to believe in any form of God, and if this is true, the requirement to create some form of higher power may also repel them. Twelve-step treatment virtually demands dependence on something other than yourself, and this is incompatible with many people’s view on their existence. Like the cook convinced his individual palate can yield a better chili than a fixed recipe, they throw out the rule book and do things their own way. Translation: they leave AA pretty quickly.
The critics say that the AA attempts to create belief in itself and therefore promotes dependence. Bill Wilson himself (the co-founder of AA) states that “You can, if you wish, make AA itself your ‘higher power.'” If this statement is considered in the context of what is actually happening at meetings, it reveals a big problem. When people attend AA meetings, they are receiving help with something they are struggling to deal with alone. They may feel like nothing can help them, and then find support in the company of peers struggling with the same issues, a thoroughly positive atmosphere and a spiritual safety net. The “higher power” that takes away their problems is the AA, and the final step tells them that after their spiritual awakening, they should “carry this message to alcoholics.” It could be argued that the AA creates believers and then recruits them as missionaries.
What Does It All Mean?
The debate about the effectiveness of twelve-step programs for addiction will undoubtedly continue, but the uncertainty must point to some inherent issue with the method. Nobody wants to see addicts drop out of treatment, but perhaps it will remain a mainstay of AA groups until the methodology is adapted to suit those who value their independence. However, the spiritual side to AA is one of the major positive factors for many addicts, so removing it may not be the best approach. It seems that free choice and transparency are central to helping the maximum number of addicts. We should admit twelve-step treatment isn’t for everybody and have viable alternatives available for those who might not suit it.
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